Provider Demographics
NPI:1942419486
Name:BRANDT, KENNETH CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:BRANDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BLUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6332
Mailing Address - Country:US
Mailing Address - Phone:513-741-8223
Mailing Address - Fax:513-741-8234
Practice Address - Street 1:2751 BLUE ROCK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6332
Practice Address - Country:US
Practice Address - Phone:513-741-8223
Practice Address - Fax:513-741-8234
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0146491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice